States mandating autism insurance coverage
The committee favorably reported a substitute bill on March 11, 2008, that eliminated the coverage requirement of the raised bill.
Instead, the substitute bill required individual and group health insurance policies delivered, issued, renewed, amended, or continued in Connecticut on or after January 1, 2009 to provide coverage for physical, speech, and occupational therapy services for the treatment of autism spectrum disorders to the extent those services are a covered benefit for other diseases and conditions under the policy.s March 11, 2008 meeting minutes show that the substitute bill was placed on the consent calendar, which passed on a 19-to-0 vote.
In the 2008 February Session, the Insurance and Real Estate Committee introduced Raised Bill 5696, An Act Requiring Insurance Coverage For Autism Spectrum Disorder Therapies.
As raised, the bill required individual and group health insurance policies delivered, issued, renewed, amended, or continued in Connecticut on or after January 1, 2009 to provide coverage for the treatment of pervasive developmental disorders (also known as autism spectrum disorders), including psychiatric, psychological, therapeutic, and habilitative care based on the principles of Applied Behavioral Analysis, which is sometimes referred to as “in-home behavioral support.”s March 6, 2008 public hearing, where numerous people spoke in favor of the bill, including legislators, health care professionals, and parents of autistic children.
We want to be very, very careful to ensure there Connor, Co-Chair of the Insurance and Real Estate Committee, indicated that the committee was “very cognizant of the fact that some of these mandates are very costly, so we tried to incorporate what was already in place in the plans, but, at the same time, draw a very defined line of what was medical and what is educational.” The House passed the bill on a 144-to-0 vote.
On May 7, 2008, the Senate placed the substitute bill on the consent calendar without discussion and passed it (36-to-0 vote).
Here is a WAMU story about this past session's efforts.
One of the big arguments against this idea is that if other states do not mandate coverage, it puts Virginia insurers and eventually companies at a competitive disadvantage with other states because their rates and costs are higher due to this additional coverage.
Requiring Virginia insurers has become a perrenial fight in the General Assembly.
Given that most states seem to be moving towards covering autism, this argument does not carry as much weight as it formerly did.
The purpose of health insurance is to help spread the risk and cost of ailments across broader populations so that the burden of medical expenses does not fall entirely upon individual families. I am hopeful that was can get this legislation moving and join the rest of the country instead of being the last one to act.
It defines “mental or nervous conditions” as mental disorders, as the term is used in the DSM-IV-TR.
The law specifically excludes from this coverage requirement (1) mental retardation; (2) learning, motor skills, communication, and caffeine-related disorders; (3) relational problems; and (4) additional conditions not otherwise defined as mental disorders in the DSM-IV-TR (CGS 38a-488a and 38a-514). Insurance must cover medically necessary early intervention services for a child from birth until age three that are part of an individualized family service plan.
Yesterday, the New York Times ran a story that New York was very close to becoming the 23rd state in the country to require insurance companies to cover autism treatments.